Afamelanotide (Scenesse)

Scenesse (afamelanotide) is covered to increase pain‑free light exposure in adults (≥18) with erythropoietic protoporphyria (including X‑linked) and is not covered for patients <18 or for non‑EPP phototoxic conditions. Coverage requires documented diagnostic confirmation (elevated free erythrocyte protoporphyrin level OR molecular genetic testing), a history of at least one porphyric phototoxic reaction, prescription by or consultation with a dermatologist, gastroenterologist, hepatologist, or porphyria specialist, authorization limited to 12 months, and dosing per label (subcutaneous implant every 2 months).

"Scenesse is indicated to increase pain free light exposure in adult patients with a history of phototoxic reactions from erythropoietic protoporphyria (EPP)."

Sign up to see full coverage criteria, indications, and limitations.